Phase Ib Study of Combination Therapy with MEK Inhibitor Binimetinib and Phosphatidylinositol 3-Kinase Inhibitor Buparlisib in Patients with Advanced Solid Tumors with RAS/RAF Alterations

Aditya Bardia, Mrinal Gounder, Jordi Rodon, Filip Janku, Martijn P Lolkema, Joe J Stephenson, Philippe L Bedard, Martin Schuler, Cristiana Sessa, Patricia LoRusso, Michael Thomas, Heiko Maacke, Helen Evans, Yongjian Sun, Daniel S W Tan, Aditya Bardia, Mrinal Gounder, Jordi Rodon, Filip Janku, Martijn P Lolkema, Joe J Stephenson, Philippe L Bedard, Martin Schuler, Cristiana Sessa, Patricia LoRusso, Michael Thomas, Heiko Maacke, Helen Evans, Yongjian Sun, Daniel S W Tan

Abstract

Background: This multicenter, open-label, phase Ib study investigated the safety and efficacy of binimetinib (MEK inhibitor) in combination with buparlisib (phosphatidylinositol 3-kinase [PI3K] inhibitor) in patients with advanced solid tumors with RAS/RAF alterations.

Materials and methods: Eighty-nine patients were enrolled in the study. Eligible patients had advanced solid tumors with disease progression after standard therapy and/or for which no standard therapy existed. Evaluable disease was mandatory, per RECIST version 1.1 and Eastern Cooperative Oncology Group performance status 0-2. Binimetinib and buparlisib combinations were explored in patients with KRAS-, NRAS-, or BRAF-mutant advanced solid tumors until the maximum tolerated dose and recommended phase II dose (RP2D) were defined. The expansion phase comprised patients with epidermal growth factor receptor (EGFR)-mutant, advanced non-small cell lung cancer, after progression on an EGFR inhibitor; advanced RAS- or BRAF-mutant ovarian cancer; or advanced non-small cell lung cancer with KRAS mutation.

Results: At data cutoff, 32/89 patients discontinued treatment because of adverse events. RP2D for continuous dosing was buparlisib 80 mg once daily/binimetinib 45 mg twice daily. The toxicity profile of the combination resulted in a lower dose intensity than anticipated. Six (12.0%) patients with RAS/BRAF-mutant ovarian cancer achieved a partial response. Pharmacokinetics of binimetinib were not altered by buparlisib. Pharmacodynamic analyses revealed downregulation of pERK and pS6 in tumor biopsies.

Conclusion: Although dual inhibition of MEK and the PI3K pathways showed promising activity in RAS/BRAF ovarian cancer, continuous dosing resulted in intolerable toxicities beyond the dose-limiting toxicity monitoring period. Alternative schedules such as pulsatile dosing may be advantageous when combining therapies.

Implications for practice: Because dysregulation of the mitogen-activated protein kinase (MAPK) and the phosphatidylinositol 3-kinase (PI3K) pathways are both frequently involved in resistance to current targeted therapies, dual inhibition of both pathways may be required to overcome resistance mechanisms to single-agent tyrosine kinase inhibitors or to treat cancers with driver mutations that cannot be directly targeted. A study investigating the safety and efficacy of combination binimetinib (MEK inhibitor) and buparlisib (PI3K inhibitor) in patients harboring alterations in the RAS/RAF pathway was conducted. The results may inform the design of future combination therapy trials in patients with tumors harboring mutations in the PI3K and MAPK pathways.

Trial registration: ClinicalTrials.gov NCT01363232.

Keywords: Binimetinib; Buparlisib; Ovarian cancer; Phase Ib; RAS/RAF.

Conflict of interest statement

Disclosures of potential conflicts of interest may be found at the end of this article.

© 2019 The Authors. The Oncologist published by Wiley Periodicals, Inc. on behalf of AlphaMed Press.

Figures

Figure 1
Figure 1
Best percentage change from baseline in sum of tumor diameters. (A): By local mutational status and treatment group (full analysis set). (B): By local mutational status (recommended phase II dose). Abbreviations: Adv, advanced; mEGFR, mutant epidermal growth factor receptor; NSCLC, non‐small cell lung cancer; PD, progressive disease; SD, stable disease; UNK, unknown.
Figure 2
Figure 2
Geometric mean plasma concentration‐time profiles after repetitive (Day 15) daily combination doses of buparlisib and binimetinib by treatment group. (A): Binimetinib. (B): Buparlisib. “tau” represents the dosing interval; tau = 12 hours for binimetinib, tau = 24 hours for buparlisib.
Figure 3
Figure 3
Immunohistochemical staining on pre‐ and postbaseline tumor biopsies (representative images shown at ×25 magnification).

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Source: PubMed

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